Racial disparity in infant mortality and very low birthweight (VLBW) have persisted in Boston despite the availability of sophisticated obstetrical and neonatal services and a network of neighborhood health centers. In 1988, Boston has the third highest infant mortality rate among other large urban cities in the United States. This proposal is designed as two population based case control studies intended to elucidate the relationship between medical, environmental, behavioral and biologic risk factors and infant mortality and very low birthweight. Infant death and VLBW infants will be identified and frequency matched to controls on Race, census tract cluster and maternal age. This sampling scheme is designed to permit us to focus on groups that we expect to have poor outcomes. Having controlled for race, and to some extent SES, the analysis is intended to uncover those factors, within high risk groups, that contribute to infant mortality and VLBW. It is intended to build upon traditional epidemiologic investigations and to employ a qualitative strategy to obtain fruitful explanations and rich descriptions of life experiences before, during and after the birth of an infant. Collecting quantitative and qualitative data will enhance our understanding of the interrelationship of medical and social precursors to infant mortality and very low birthweight and to clarify specific aspects of the health care system that are amenable to policy and programmatic change. The ability to make intelligent decisions is, to a large extent, dependent on the availability of quality information. This proposed project will provide quality medical and social data on which appropriate interventions could be planned, implemented and evaluated.